The relationship between neurocognitive performance and sport-related musculoskeletal injury

Abstract

Background: The number of sport-related musculoskeletal (MSK) injuries continues to rise even with an increase in prevention programs. The potential relationship between neurocognitive performance and sport-related MSK injury has begun to emerge in the literature, with results suggesting that athletes with lower baseline neurocognition sustain more injuries compared to those with higher baseline neurocognition. Purpose: This study aims to build on the previous literature by investigating this relationship while controlling for variables that have been well-documented as predisposing factors for injury (i.e., previous MSK and brain injury). Methods: A total of 87 participants from the University of Regina Rams football team were included in the study. Baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) data (Verbal Memory Composite, Visual Memory Composite, Visual Motor Speed Composite, Reaction Time Composite, and Impulse Control Composite), MSK injury history, concussion history, and number of games participated were all gathered. Acute lower extremity (LE) MSK injuries that occurred over the course of the six-game, 11-week season were recorded and included in the analysis. Two statistical analyses were conducted: linear and logistic regression. Both regression analyses used a hierarchical method with step 1 including independent variables of previous LE MSK injury and previous concussion history. Step 2 involved the addition of the number of games played as an independent variable and step 3 involved the addition of all neurocognition measures as independent variables (Verbal Memory, Visual Memory, Visual Motor, Reaction Time, and Impulse Control). The dependent variable for the linear regression was the severity of injury, measured as the number of days from time of injury to full return to sport with no restrictions. The dependent variable for the logistic regression was injury versus no injury. Results: Sixteen (18.4%) of the participants suffered an injury over the course of the season, with the average (standard deviation [SD]) injury severity being 3.77 (10.24) days. Step 2 (number of games played) had the largest impact on both regression models. Having played 1-2 games in the six-game season was the only independent variable to make a statistically significant contribution to predicting injury severity (β = .338, p = .005) and injury occurrence (OR [95%CI] = 19.880 [2.239, 176.477], Wald = 7.202, p = .007). The final logistic regression model correctly classified 18.8% of injured participants and 98.6% of non-injured participants. Conclusion: Playing in 1-2 games in a six-game season was the only statistically significant independent variable at predicting both musculoskeletal injury occurrence and severity. There are several limitations to this study affecting the generalizability of the results. The assumptions of linearity, homoscedasticity, and normality were not met in the data, and there was a small number of injuries due to the small sample size and short follow-up period. More research is needed in this area, particularly involving other populations outside of collegiate level football athletes, longer study periods, and the potential relationship between executive functioning and MSK injury.